Narrative review

Climate change: a brief overview of the scienceand health impacts for AustraliaElizabeth G Hanna1, Lachlan J McIver2

Summary

n 2017, The Lancet reported that “human symptoms of climatechange are unequivocal and potentially irreversible— affecting � The scientific relationship between atmospheric CO2 and

global temperatures has been understood for over a century.� Atmospheric concentrations of CO2 due to burning of fossil

fuels have contributed to 75% of the observed 1�C rise inglobal temperatures since the start of the industrial era(about 1750).

� Global warming is associated with intensifying climaticextremes and disruption to human society and human health.

� Mitigation is vital for human health as continued currentemission rates are likely to lead to 4�C of warming by 2100.

� Further escalation of Australia’s hot and erratic climatewill lead to more extreme climate-related disasters ofheatwaves, droughts, fires and storms, as well as shifts indisease burdens.

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I the health of populations around the world today” and addedthat the “delayed response to climate change over the past 25 yearshas jeopardised human life and livelihoods”.1 The gravity ofthis situation warrants inspection, and urgent action. In thisarticle, our aim is to provide an overview of the most recentscientific and organisational literature to inform readers aboutthe current state of knowledge on climate change and its rela-tionship to human health. The issue has global relevance, buthere we focus primarily on Australia.

The ambient climate shapes cultural life, so the relationshipbetween human societies and their climate is extremely powerful.Ecological services such as food and water resources, strategiesrequired to feed a community throughout the year, clothing, andhousing design are all determined by climate and its direct threatsof heat, droughts, fires, storms and floods. Indeed, human survivaland societal flourishing depend on successful adaptation to theproclivities of regional climate.

More than a century ago, science accurately explained therelationship between atmospheric carbon dioxide (CO2) levels,greenhouse effect and planetary energy balance, and in the 1930sglobal warmingwas observed.2 Yet, the prevailing public thinkingwas that humans could never significantly influence planetaryforces or the climate.

During the past 2.6 million years (Pleistocene and Holocene),atmospheric CO2 levels have oscillated between about 180 partsper million (ppm) during ice ages, and about 280 ppm duringwarmer interglacial periods.3 Closely aligned with atmosphericCO2 levels is global mean temperature. Importantly, a mere 5�Cdifferentiates ice ages from interglacial periods4 (Box 1).

The evidence for human influence on climate change

Human interference in the global climate is now apparent. Overthe past 150 years, atmospheric CO2 concentrations have risenrapidly from a 12 000 year steady level of 280 ppm to 410 ppm,6 alevel not seen since the Pliocene (5.3e2.6 million years ago).7 Asprojected by the laws of thermodynamics, this 46% rise in atmo-spheric CO2 has been accompanied by rising global averagetemperatures. Human influences on climate change arise pri-marily from combustion of fossil fuels and changes in land use.8

The capacity of a gas or other agent to affect atmospheric energybalance, thereby contributing to climate change, is measured asradiative forcing (watts per square metre). Human activities causesignificant changes in concentrations of long-lived gases (eg, CO2,

halocarbons, nitrous oxide), short-lived gases (eg, methane thatlingers in the atmosphere for a year to a few decades), surfacealbedo, aerosols and contrails in the atmosphere. Box 2 provides asummary of these principal components of the radiative forcing ofclimate change for 2011 relative to the start of the industrial era

1 Fenner School of Environment and Society and Climate Change Institute, Australian NLiz.Hanna@anu.edu.au j doi: 10.5694/mja17.00640 j Published online 09/04/2018 j Se

Podcast with Liz Hanna available at https://www.mja.com.au/podcasts

(about 1750). Positive forcings lead to warming of climate andnegative forcings lead to cooling. Anthropogenic emissions elicit awarming effect,whereas atmospheric aerosols cool the atmosphereby blocking incoming energy from the sun. Natural variation insolar radiance provides a relatively very small positive forcing(warming) effect. Box 3 shows the effective radiative forcing,whichis the net effect of the positive forcing of greenhouse gases,moderated by the cooling effect of aerosols to give the totalanthropogenic forcing in watts per square metre over the Earth.

Despite growing awareness, by 2017 emissions had not yetstabilised.Over the past twoyears, global emissions have continuedto increase at a record rate of almost 3 ppm per year.10 This is morethan 100 times faster than when the last ice age ended.11

Future warming is dependent on levels of economic and popula-tion growth, and future emission trajectories. Developed in 2010,12

the Intergovernmental Panel on Climate Change in its most recentassessment report adopted scenarios to serve as the basis formodelling and describing climate projections.13 These four repre-sentative concentration pathways (RCPs) are based on possibleradiative forcing values. The RCPs range from the worst-casescenario of business as usual with continued high growthand high emissions (RCP8.5), to the best-case scenario whereemissions stabilise at 2013 levels until 2020, followed by declineand becoming negative by 2100 (RCP2.6), and include twointermediary scenarios (Box 4).

The urgent need to reduce emissions

Theurgencyof initiating emissions reductions iswell recognised asscientists are increasingly arguing that limiting warming to 2�Cis no longer feasible; yet this level of warming may have unac-ceptable social and environmental costs and trigger irreversibleclimate feedbacks.14,15 Mitigating climate change now is lessdisruptive than the consequences of not mitigating; moreover,

ational University, Canberra, ACT. 2M�edecins Sans Fronti�eres, Geneva, Switzerland.e Editorial, p. 296 311

1 Global average temperatures and atmospheric CO2 levelsfor the past 800 000 years

Reproduced with permission from Henley and Abram.5 u

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delayed mitigation will need to be very drastic. For example,palaeoclimate records indicate that temperatures matching 2016did, when sustained, correspond to a global sea level between6 and 9 metres higher than that of today,16 a change which wouldlikely create millions of climate refugees seeking refuge inAustralia. Currently, 30% of theworld’s population are exposed toclimatic conditions exceeding lethal heat thresholds (defined asprecipitating multiple heat deaths) for at least 20 days a year. By2100, this proportion is projected to increase to 48% with drasticreductions of greenhouse gas emissions, and to 74% under a sce-nario of growing emissions.17

Even if drastic emission reductions were immediately introduced,embedded climate system inertia dictates that observed globaltrends such as rainfall anomalies, extreme temperatures and sealevel rises will continue for many millennia.18 Control of futureglobal warming therefore depends upon global cooperation andefficacy in reducing carbon emissions.

Evidence that the combustion of fossil fuels is responsible for about75% of the additional atmospheric carbon19 is found in the carbonembedded within tree rings and bubbles within ice cores.20 Theseshow that the atmospheric 13C:12C isotope ratio has distinctively

2 Radiative forcing of climate for the period 1750e2011

Reproduced with permission from Working Group I Contribution to IPCC AR5 (Figure 8.15Radiative forcing is shown as hatched and effective radiative forcing as solid. Uncertaint(95% CI) are shown for radiative forcing as dotted lines and for effective radiative forcinglines. u

decreased since the industrial revolution.21 The photosyntheticprocess alters the 13C:12C ratio in plants from the atmospheric ratio,and burning fossilised plant material releases the 12C isotopes thatplants absorbed millions of years ago into the atmosphere in theform of CO2 molecules.22

In addition to absorbing 90%of the additional heat,23 global oceanshave absorbed about 27% of anthropogenic CO2 emissions sincethe beginning of the industrial revolution,19 which has loweredocean pH by 0.1 units.24 Marine organisms and ecosystems areparticularly sensitive to ocean acidification.25 For example,exoskeleton formation of krill, at the base of the marine food web,relies on a stable marine carbonate system. Currently, 3.1 billionpeople derive at least 20% of their animal protein sourcesfrom fish.26 Significant nutritional deficits could arise frommarine fisheries stock losses when acidification and warmingsea temperatures compound existing threats from overfishing.

Climate change threats to the health of Australians

Despite being a wealthy developed nation, Australia is highlyvulnerable to climate change, due largely to its unique geoclimaticfeatures. Australia is the driest inhabited continent on earth27 andhas the greatest variability of rainfall of any country. Further,Australia’s average daily temperature is 13.7�C warmer than theglobal average of 8.1�C28 and is getting hotter, with newlyobserved hot-to-cold temperature records now at a ratio of 12:1.29

Heat extremes are the most risky. Box 5 demonstrates the almostfivefold increase in frequency of extreme temperatures (> 2 stan-dard deviations above the average) despite relatively smallincreases in mean temperatures.30

Claiming at least 5332 fatalities between 1844 and 2010, heatexposure is more lethal than any other natural disaster31 andrepresents Australia’s greatest current climate-related healthburden. Winter cold-related deaths arise predominantly throughrespiratory diseases, often with contributing socio-economicdeterminants, rather than through direct exposure.32 In contrast,heat deaths are exposure related.Heat death occurswhenheat gainexceeds the capacity to shed heat to a hot ambient environment.Thermoregulatory response fails, and cardiac compromised

).9

iesas solid

patients succumbdue to the inability of the heart tomeetperfusion needs of increased shunting of blood fortemperature control, especially when dehydrated.33

Heat gain ultimately results in multi-organ failure.

Entire populations cannot exist permanently inair-conditioned environments during heat waves.Human thermoregulatory limitations therefore placeupper boundaries to human heat tolerance and thussurvivability in a warming climate.33 Internationalconsistency exists in the temperatureemortality rela-tionship as a J-shaped curve. Adaptation to cold envi-ronments is reflected in variability and a relativeshallow rise, whereas above the comfort threshold, heatmortality rises steeply, indicating thermotolerance andadaptation limitations (Box 6).

A combination of heat anddrought precipitates highfirerisk. In the period 1901e2011, 260 Australian bushfiresresulted in 825 reported civilian and firefighter fatal-ities.36 The number of admitted and non-admittedinjuries and burns cases since 1901 remains unknown.Large fires exacerbate existing respiratory conditions37

and elicit chronic mental health morbidity secondaryto loss and grief, and sometimes guilt.38 Extreme fire

5 Distribution of Australian monthly daytime temperatureanomalies (standardised with respect to the 1951e1980base period) aggregated across 104 locations andall months of the year, for 1951e1980, 1981e2010 and2001e2015

Reproduced with permission from BOM, CSIRO. State of the Climate 2016.30 u

3 Probability density function of effective radiative forcing(RF) of climate for the period 1750e2011

Reproduced with permission from Working Group I Contribution to IPCC AR5(Figure 8.16).9 Lines at the top of the figure compare the best estimates anduncertainty ranges (95% CI) for aerosol, greenhouse gas and total anthropogenicchange with RF estimates from Climate change 2007: synthesis report.Contribution of Working Groups I, II and III to the Fourth Assessment Report ofthe Intergovernmental Panel on Climate Change. Geneva: IPCC, 2007 (AR4). u

Narrative review

weather has increased over recent decades, and across large partsof Australia, the fire season now extends further into springand autumn.30,39

Climate change influence on Australia’s rainfall variability has ledto increased droughts and floods.39 MayeJuly rainfall has reducedby about 19% since 1970 in the southwest of Australia, whereas thecontinental southeast has experienced an 11% decline in rainfallsince the mid-1990s during the important AprileOctober growingseason. All climate models project increases in extreme droughtsacross Southern Australia (occurring between 1.5 and 2.7 timesevery 20 years), and by 2090, time spent in drought ranges from35% to 80%.30,39 Droughts reducewater supply andquality, posing

4 Global mean temperature change projections to 2100relative to 1986e2005 for the four representativeconcentration pathway (RCP) scenarios: RCP2.6, RCP4.5,RCP6.0 and RCP8.5

Reproduced with permission from Working Group I Contribution to IPCC AR5 (FAQ12.1, Figure 1).13 u

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health risks to stock and to communities reliant on inland riversystems for their water supply40 and economic livelihood.

Despite near-national water restrictions during the protractedMillenniumdrought,many farmers and rural townships ran out ofwater, and some were listed as unviable. Rural families andregional communities suffered deep economic losses and ruralsuicides spiked.41 About 9% of total deaths in New South Walesmen aged 30e49 years between 1970 and 2007 were drought-related suicides.41

Between 1900 and 2015, the total number of recorded deaths fromfloods inAustraliawas 1859, an average national annual death rateof 2.91 fatalities per 100 000 people per year.42 Death rates havesteadilydeclinedover time. TheQueenslandfloodsof 2011 claimedthe lives of 23 people, and generated 56 200 insurance claims, withpayouts totalling $2.55 billion.43 Many were uninsured, and pay-outs do not fully recompense loss and wide scale lingering griefamong affected communities. Emergency and recovery responsecapacities can be overwhelmed in natural disasters.

Attributingprobability risks of rainfall changes to climate change isa more difficult task than attributing temperature changes. This isespecially so in Australia, where intrinsic rainfall variability oninterannual and interdecadal timescales is uncommonly large.Notwithstanding, studies suggest that the high sea surfacetemperatures currently contribute 20% (mean estimate) of rainfallanomalies.39 Continued current high emission scenarios will resultin more severe flooding events.44

Australia’s large geographical landmass delivers variation inregional rainfall patterns and differentiated future climate pro-jections. Excluding southwestern Western Australia, extremerainfall events (wettest day of the year andwettest day in 20 years)are projected to increase in intensity with high confidence (defined

6 Schematic representation of temperatureemortality curvebased on study data34,35

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by the Intergovernmental Panel on Climate Change as> 80% probability of being correct).39

Tropical cyclones are the most devastating weather systemsaffecting northern Australia. Strong natural variability preventsdetection of statistically robust trends; however, a 50% increase inthe proportion of tropical cyclones reaching category 3 or higherwas recorded from the period 1960e85 to the period 1985e2010.45

The low frequency of tropical cyclonesmaking landfall inAustraliaprevents statistical certitude in projecting future probabilities. Thephysical science, however, suggests clear risks: higher sea surfacetemperatures are associated with more energy, higher windspeeds, more intense tropical cyclones and higher rainfallintensity,46 and thus likely greater damage to human systems. Thetotal numbers of tropical cyclones are expected to be similar ordecline in frequency in the Australian region by 2050, yet theirseveritywill potentially increase,with an associatedpoleward shiftin the regions of both genesis and dissipation.47

Extensive flooding and cyclone damage impede essential services,delivery of health care, repairs to infrastructure and economicrecovery.Affected communities face agauntlet of associatedhealthproblems including acute effects of drownings, falls, electrocu-tions, bites, skin infections and mosquito- and gastrointestinal-borne illnesses, as well as protracted grief and psychologicalhealth issues.

A growing body of literature links climate change to food andwater insecurity and increased disease burden.48 Recent andhistorical experiences indicate that infectious disease outbreaks

often follow extreme rainfall events,49 although Australians’health risk is considerably less than that of developingcountries.50 Many vector-borne diseases are climate sensi-tive, as mosquito densities relate to rainfall and temperature.In Australia, Ross River virus, Barmah Forest virus anddengue fever are three of the most common and clinicallyimportant vector-borne diseases,51 yet the relationshipbetween disease outbreaks and climate change is less clear.For example, rainfall was the weakest predictor of vector-borne disease burden in a recent Australian study thatexplored climate variables on Ross River virus, BarmahForest virus and dengue transmission rates, as the homo-philic vector breeding cycle responds also to humanintervention such as travel, habitation patterns, watercontainers51 and prevention campaigns.

Locally acquired dengue transmission only occurs inurban areas of north Queensland from Townsville to theTorres Strait, where the vector (Aedes aegypti) is present.52

Australia’s increasing incidence of dengue fever is thoughtto result primarily from the long term growth in the travelsector, notably to South EastAsian locationswhere dengue isendemic.51 With global increases in vectorial capacity since

the late 1970s ofA. aegypti andA. albopictus,48 endemicity of denguefever in northern Queensland is regarded as a very real possibil-ity.52 A warming world suggests that the environmental niche formosquitos will move southward, yet the complexities ofhumaneenvironment interactions and efficacy of preventioncampaigns, surveillance and medical management make futuredisease burdens difficult to quantify.

Conclusion

Australia’s climate is changing. Adaptation is required and,perhapsmore importantly,mitigation to avoid theworst of futurehealth burdens. Current trends suggest a future of increasingheatwaves, even greater rainfall variability, and more fires.Additional heat is likely to generate fewer winter respiratorydeaths yet more heat exposure morbidity and mortality. Furtherexacerbations of Australia’s extreme rainfall variability willintensify water shortages and storm and flood damage, com-pounded by likely societal interruptions and health challenges.The picture for climate-sensitive vector-borne diseases remainsunclear, although cases spreading to southern regions remainpossible. A realignment of health services to address the shift indisease burden is required to secure Australia’s current high levelof health care.

Competing interests: No relevant disclosures.

Provenance: Commissioned; externally peer reviewed.n

ª 2018 AMPCo Pty Ltd. Produced with Elsevier B.V. All rights reserved.

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